Redesign of Birmingham-Solihull NHS services ‘secretive and a recipe for disaster’

The biggest redesign of NHS and social care services in a generation is taking place in secret and is a recipe for disaster, Birmingham city councillors have claimed.

Reflecting mounting local government concern about integrating GPs, hospitals and social services for older adults through NHS-led Sustainability and Transformation Plans (STPs), some members of the city’s health scrutiny committee said they feared controversial cost-cutting proposals were being forced through without proper consultation.

A five-year STP is being drawn up for Birmingham and Solihull and initial ideas will be published by the end of next month. Successful delivery of the STP is important for Birmingham city council which is relying on Government funding for the transformation of services to help plug a budget deficit.

Although councils have been involved in discussions with hospitals and GPs for months, the NHS has banned details of STP proposals from being released until after October 21.

The financial challenges behind the STP are huge. Current projections predict a £713 million shortfall in resources for adult social care in Birmingham and Solihull by 2020-21.

Closer working between social services and the NHS, crucially by helping to keep older people out of hospital with improved community care, could trim the deficit to £191 million.

Labour councillors claimed the secretive process would damage the reputation of Birmingham city council which has a commitment to openness and transparency.

Health scrutiny committee chair Cllr John Cotton said getting to grips with proposals for the STP was “like wrestling with the invisible man”.

Cllr Karen McCarthy (Lab Selly Oak) did not believe the STP proposals, having been worked on for a year, would ever be changed after a period of consultation. “This process is fatally flawed. This is the biggest service redesign we are likely to see in our lifetimes and there has been no public involvement whatsoever. It is a recipe for disaster.”

Cllr Rob Pocock (Lab Sutton Vesey) said: “The public have been excluded from taking any part in designing these plans so far. Birmingham needs to lay a marker in the sand and say ‘we won’t be party to a process that excludes the public’.”

Peter Hay, Strategic Director for People at Birmingham city council, attempted to play down fears that a non-negotiable STP would be launched. Mr Hay said “possible options and lose formative ideas” would be put forward. He rejected suggestions that discussions about the STP had involved proposals to close hospitals.

Describing the STP as “the only game in town” Mr Hay said the challenge was to find ways of integrating NHS and council services to provide a better quality of care for older people. But the council had to play by NHS rules under regulations laid down by the Government.

He wanted to put an end to a system where an elderly person could all too often “end up in an ambulance and a hospital because of something as simple as a fall at home” and then spend months in a ward before being discharged.

Years of under-investment in residential and nursing care in Birmingham combined with pressures arising from the National Living Wage was putting increasing pressure on the NHS, he added.

Mr Hay admitted there was a long way to go until the STP could be put in place. “We haven’t made a great deal of progress,” he added.

Health and social care cabinet member Paulette Hamilton said: “If we don’t make changes in financing social care and the NHS by 2020 then we become unsustainable.”

Government guidance states that the STP must cover “better integration with local authority services, including, but not limited to, prevention and social care, reflecting local agreed health and wellbeing strategies”.

A report to the Birmingham scrutiny committee hints at pressures behind the scenes:

Trying to identify how to balance the health and care system is one of the most challenging issues of our time. At this stage all that has taken place is to develop a set of initial management options and a great deal of work needs to be done to develop the transformational aspects of the approach and to start the work that turns such plans into a reality.

Our plans are not as advanced as in other areas – as this is the first time we have come together as a footprint to work in this way. It has taken time for us to make progress to the point that we have a sense of how we might begin to tackle the health and wellbeing, care and quality and financial gaps ahead.

Once we have undertaken a sense-check on thinking so far, we will be in the position to plan out additional and more widespread engagement on the STP proposals with a much wider audience.

It must be made absolutely clear that the planning document is a work in progress, it is a high level plan, no decisions have been made and no decisions will be made without proper consultation process being followed by the NHS and by the local authority.

This whole issue has been one that is extremely challenging, particularly for how local government engages with the plans. Birmingham and Solihull councils have been clear to reach an agreement within the local leaders and chairs group that the STP for this footprint is a work in progress and that we are all aware of the huge amount of work that is still needed, particularly to engage and develop proposals with the local population.

“Understandably local government partners in STPs have stressed the importance of public engagement and confidence, and there is a major task ahead for leaders to move from discussions between themselves to leading local people through the choices entailed in creating a sustainable health and care economy.